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Meeting Needs
Which type of facility is right for you or your loved one?


June 2017

Assisted living is often used as a blanket term to refer to any type of residence that caters to seniors. The reality, however, is that assisted living encompasses a variety of facilities, with some important distinctions. Understanding the differences is key to finding one that best suits your needs or your loved one’s.

In Wisconsin, the state sanctions three types of assisted-living facilities: community-based residential facilities (CBRF), residential care apartment complexes (RCAC) and adult family homes (AFH).


A CBRF is a place where five or more unrelated people live together in a community setting. Services are limited to room and board and assistance with activities of daily living, including toileting, dressing and bathing. Three hours of nursing care per week is occasionally included too. According to the Wisconsin Department of Health Services, CBRFs range in size from five to 257 beds, and the minimum age requirement for residing in a CBRF is 18 years. In addition to the elderly, residents can include people suffering from dementia, developmental disabilities, mental health problems, physical disabilities and traumatic brain injury, among others.

“Per CBRF licensure guidelines, if a resident requires more than three hours of skilled care per week, they would need to transition to a skilled nursing facility. Skilled nursing facilities offer licensed nurses, physical and occupational therapists, (and) audiologists, and can provide emergency, restorative or rehabilitation care, including intravenous medicines, feeding tubes, etc.,” says Debbie Harry-Miller, vice president of sales and marketing at Heritage Senior Living.


The Wisconsin Department of Health Services defines an RCAC as an independent apartment complex where five or more adults reside. Sizes of RCACs in Wisconsin vary from five to 109 individual apartments.

All apartments are required to have a lockable entrance and exit and must include a kitchen, individual bathroom, and sleeping and living areas. Residents receive up to 28 hours of services per week, and services vary from general housekeeping and transportation to community services and recreational activities to daily activities like dressing, eating, bathing and grooming. Nursing services include health monitoring, medication administration and medication management. An RCAC must also provide emergency assistance 24 hours a day.

“The primary difference between CBRF and RCAC is that an individual can have an activated power of attorney upon admission to a CBRF, but not to an RCAC. If a senior is already residing in an RCAC and needs to activate their power of attorney, they can do so and stay in the RCAC. It’s only at initial admission that it’s an obstacle,” explains Adele Lund, director of business and community relations at the Laureate Group.


Finally, an AFH facility is limited to three or four adults who receive care, treatment or services above the level of room and board. The limit requires that a maximum of seven hours per week of nursing care be provided.


Memory Care Centers

Many assisted-living communities have specific memory care units designed for individuals suffering from Alzheimer’s disease and other types of dementia. These facilities can be found within all levels of senior living. The key is determining the degree and type of memory loss. Typically, assisted living serves a population of early and mid-stage dementia, whereas late-stage patients are moved to a nursing home. Some memory care assisted-living residences are secure areas equipped with wander management technology, which assists those suffering from Alzheimer’s.

Continuum of Care Facilities

These facilities run the spectrum — with independent-living apartments, adult day services, skilled nursing, rehabilitation services and even hospice services. “A continuum like this provides peace of mind for the entire family, knowing that services are available if and when they are needed,” says Carey Bartlett, vice president of client relations at the Lutheran Home & Harwood Place.

When deciding which facility best suits your needs, think long term. “Consumers need to understand what their loved ones’ specific needs are — both today as well as what the future may hold based upon their diagnosis,” Lund says. “When touring a senior community, find out what the depth of the care is they provide. What happens if the care needs change? At what point would they no longer be able to meet their needs? These are questions that have to be answered.”

Bartlett says that finding the right place can be overwhelming, but she warns that waiting for a crisis to occur before studying your options is a mistake. “When working in crisis mode, decisions are made quickly and often without all the pertinent information,” she explains. “In the worst-case scenario, your family will have to make the selection for you. It’s best to start the search when you are healthy and able to drive the process. The goal is to select a community that offers the lifestyle you envision with the right blend of services to support your independence as you age. And plan on it taking anywhere from six months to two years to find the right fit for you.”


This story ran in the June 2017 issue of: